Environmental health should be one of the biggest priorities for the government of Nepal to minimize the burden of infectious and increasing level of non-communicable diseases
The environment we live in determines the general wellbeing of individuals and societies, including positive and negative aspects of life and satisfaction. Living in healthy environment promotes quality of life. In contrast, exposures to air, water, and soil pollution, chemicals, climate change, and ultraviolet radiation from unhealthy environment contribute more than 100 types of diseases and injuries.
As in other low-income countries, there are several serious environmental health problems facing inhabitants of Nepal. Institute of Health Matrics and Evaluation, an independent global health research center of the University of Washington, has stated that high disease burden associated with environmental risk factors is the second major cause of deaths and disability and one of the most challenging health issues of Nepal. The most frightening existing environmental health issues of Nepal are air pollution, weather-extremes, disasters, climate change and food insecurity. Nepal’s air quality is considered among the worst in South Asia. According to a recent study by BreathLife, a partnership campaign of WHO, UN Environment, World Bank and Climate and Clean Air Coalition, a total of 37,399 annual deaths in Nepal are caused together by indoor and outdoor air pollution. As mentioned by Reliefweb in 2019, Nepal is one of the most disaster-prone counties in the world, and every year more than 1000 people are killed by landslides and flood. Similarly, seasonal mortality associated with other weather-extremes such as heatwaves, cold waves and drought is common among Nepali people.
Climate change is one of the biggest global health challenges of the 21st century. Nepal cannot stay safe from its direct and indirect adverse impacts. The emergence of different climate-sensitive vector-borne diseases (VBDs) such as Japanese encephalitis, dengue, scrub typhus, chikungunya and West-Nile in Nepal in different intervals indicates the alarming health situation. Frequent epidemics of some of them lead to the hundreds of annual deaths. Environmental degradation can also lead to major nutrition-health problems. Malnutrition is still prevalent in Nepal, mainly among young children, adolescent and new mothers. According to UNICEF, nearly half of the Nepali children are still malnourished.
These facts show that environmental health should be one of the biggest priorities for the government of Nepal to minimize the burden of infectious and increasing level of non-communicable diseases, reduce the malnutrition through the promotion of food security and minimize health impacts from climate extremes. The knowledge on anticipation of any adverse climate circumstances plays a vital role in timely preparedness which is essential to minimize the possible damages and economic and property losses.
For instance, epidemics of dengue-like VBDs can be predicted in the support of climate-based models and vector dynamics in the environment. Climate-based studies from Singapore, Sri Lanka and Vietnam offer successful evidence in dengue incidence forecasting. Similarly, climate influences on diseases like seasonal-flu and diarrhea are modeled and forecasted in different countries. Bangladesh, Tanzania and Ethiopia have also been successful in reducing impacts of drought and flood on malnutrition by altering the cropping system, and production of resistant varieties. This shows how useful it is to prioritize environmental health works within the public health domain of a country.
Working on environmental health can be fairly complicated. The environmental health of a person or community is monitored based on how external elements are impacting the mental, emotional, and physical health of individuals. In developed and most of the developing countries, the highest priority is given to environmental health research in academia. Such evidence-based policy formulation can be a good learning for Nepal to deal effectively with environmental health issues. If not, programs and policies prepared absolutely through clinical or drug-dependence treatment aspect even for minor complications might create an obstacle to achieving SGD goals of zero hunger, health and well-being. Nepal, therefore, has to tailor its health system in ecological model.
This requires knowledge and skills of serial interventions with statistical modeling in handling the disease, climate and other datasets. The accurate findings provide the impact of environmental factors such as temperatures, sunshine, solar radiation, rainfall, humidity, wind velocity, water and soil quality including sea surface temperatures on development of particular health outcome. In this view, well-maintained daily electronic databases on climate, air, and water quality and diseases are necessary. Working on data certainly can generate more scientific evidence on particular health issue and inclusion of such findings in the policy maintain program sustainability. Conversely, the healthy living in healthy environment is critical to save different progenies from the adverse impacts of carcinogens, exposure from pollutants and other environmental factors. Otherwise, exposure to environmental degradation may be life-threatening to individuals.
The evidence such as neurodegeneration from air pollution among the children of Delhi, detection of air pollutant particle in the placental fluid of pregnant women in Scotland and lung cancer, chronic pulmonary obstructive diseases (COPD) and noncommunicable diseases like ischemic heart diseases, stroke, etc from the environmental exposure in several countries of the should make us alert about living in healthy environment. These evidences certainly enhance the necessities of environmental health promotion in Nepal. We should know how individuals are exposed to pollutants in indoor and outdoor environment and how we can secure our and our children’s health.
Moreover, environmental health addresses all the human health-related issues which include handling of disease control, water quality, food management, housing and transportation, air pollution, climate change, exposure to toxic chemicals and waste management. Therefore, assessment of health impacts on each disease from Nepali perspective is essential. In this context, Ministry of Health and Population needs to collaborate with Ministry of Forestry and Environment, Environmental Epidemiologists, academia and related stakeholders to address the current and long-term health issues, for effective project planning and their fruitful implementation.
The author is an Assistant Professor in Environmental Health at Manmohan Memorial Institute of Health Sciences
Dr Yadav Prasad Joshi